Complex environments such as acute care have an increased level of risk to the patient when inexperienced learners are part of the healthcare team.(McGaghie, 2010) Adverse events in healthcare occur due to the poor execution of non-technical skills (communication and decision making).(Lewis, 2012) The Academy of Acute Care identified core competencies to incorporate into PT education to bridge the gap from classroom to clinic.(APTA, 2015) These competencies include the need for physical therapists to communicate changes in a patient’s status in a timely, professional manner as well as adapting to a critical and dynamic environment.(Gorman,2010) The Situation-Background-Assessment-Recommendation (SBAR) tool is useful in communicating relevant, succinct information between healthcare professionals.(Andreoli,2010) With the inability to guarantee access to all students to an acute care setting, high fidelity human simulation experiences (HFHS) allow for realistic interactions in a variety of patient populations.(Kameg,2010) The high utility of HFHS within nursing and medicine lends itself to collaborative experiences that replicate interprofessional care.
The purpose of this presentation is to outline the successful installation of an interprofessional HFHS experience emphasizing non-technical skills of structured communication and clinical reasoning. Lessons learned will be presented with supporting evidence, addressing large class sizes, single experience, benefits to student self-efficacy, and feedback methods.
DPT students (n > 70) were provided a case chart of a patient post op day 1 total hip replacement. Faculty voiced patient responses during the 15 minute HFHS interview. 3-4 scenarios involving potentially life threatening conditions not previously charted were portrayed. Nursing students participated in SBAR communication before/after the patient encounter. Students completed a self-efficacy survey and a narrative reflection immediately after the HFHS. Group debrief occurred later that same day.
Self-efficacy questions highlighted the challenge of maintaing confidence while engaged in an evolving situation. Responses on communication and clinical reasoning demonstrated differences in student responses depending on scenario assigned. For example, in the presentation of a patient with DVT, students showed a decrease in perceived confidence for communicating the plan of care effectively to the nurse. Reflective comments from the students indicate a single HFHS experience assists to prepare for an acute care environment. Overall, student surveys of the experience were overwhelmingly positive indicating a place for the "unique", "new", and "collaboration" of HFHS experiences.
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
HFHS technology can bridge the gap from classroom to clinic. Students are exposed to real life situations in a simulated complex acute care environment. HFHS provides a safe, valuable, low penalty experience that fosters clinical reasoning and interprofessional communication.
Andreoli, A., Fancott, C., Velji, K., Baker, G. R., Solway, S., Aimone, E., & Tardif, G. (2010). Using SBAR to communicate falls risk and management in inter-professional rehabilitation teams. Healthc Q, 13 Spec No, 94-101.
Gorman, S., Wruble Hakim, E., & Johnson, W. (2010). National acute care physical therapist practice analysis identifies knowledge, skills, and behaviors that reflect acute care practice. Phys Ther, 90, 1453-1467.
Greenwood, K., Stuart, E., Milton, E., Hake, M., Mitchell, L., Sanders, B. (2015). Core competencies for entry-level practice in acute care physical therapy. Academy of Acute Care. APTA.
Jette, D., Bertonia, A., & Coots, R. (2007). Clinical instructors' perception of behaviors that comprise entry-level clincial performance in physical therapist student: qualitative study. Phys Ther, 87, 833-843.
Kameg, K., Howard, V. M., Clochesy, J., Mitchell, A. M., & Suresky, J. M. (2010). The impact of high fidelity human simulation on self-efficacy of communication skills. Issues in Mental Health Nursing, 31(5), 315-323. doi: 10.3109/01612840903420331
Lewis, R., Strachan, A., & Smith, M. M. (2012). Is High Fidelity Simulation the Most Effective Method for the Development of Non-Technical Skills in Nursing? A Review of the Current Evidence. The Open Nursing Journal, 6, 82-89. doi:10.2174/1874434601206010082